硕通镜联合输尿管软镜下钬激光治疗肾盂旁囊肿及肾内结石临床观察

Therapeutic effect of Shuo Tong ureteroscopy combined with ureteroscope holmium laser on the treatment of pararenal cysts and kidney stones

目的肾结石合并肾盂旁囊肿临床并不少见,目前治疗无统一标准。本研究探讨硕通镜联合输尿管软镜下钬激光治疗肾盂旁囊肿及肾内结石的安全性和可行性并评估疗效。方法选择南华大学附属第二医院2017-03-01-2019-03-01收治的25例肾盂旁囊肿合并肾结石患者作为研究对象,全身麻醉下行硕通镜联合输尿管软镜下钬激光治疗。采用硕通镜进入肾盂,使用钬激光碎石;输尿管软镜逆行进入肾盂,使用钬激光将硕通镜未处理的残余结石击碎,软镜找到囊肿,使用钬激光在囊肿压迫肾盂最明显处切开,使其与集合系统完全相通,并留置双J管引流。观察患者体温变化,术后24h内常规抽血检查肾脏功能(肌酐);术后复查超声或KUB及CT。结果25例患者,术中和术后无大出血;手术时间35~60min,平均手术时间(47±6.8)min;术后无发热,肌酐67~123μmol/L,平均(86.6±18.21)μmol/L;术后住院时间3~12d,平均住院时间(5.92±2.38)d。术后患者无漏尿,无尿源性脓血症等并发症发生。术后患者临床症状全部消失,随访3~24个月,20例肾盂旁囊肿完全消失,5例肾盂旁囊肿减小>50%;25例肾结石基本清除。结论硕通镜联合输尿管软镜下钬激光治疗肾盂旁囊肿及肾内结石,可以减少尿路逆行感染的发生,保证患者术后安全。

OBJECTIVE Kidney stones with parapyelic cysts are not uncommon clinically,and there is no uniform standard for treatment at present.The safety and feasibility of Shuo Tong ureteroscopy combined with Flexible ureterscope holmium laser in the treatment of Parapelvic cyst and kidney stone.METHODS A total of 25 patients with parapelvic cysts and kidney stones admitted to the Second Affiliated Hospital of the University of South China from March 1,2017 to March 1,2019 were selected as the research object.Under general anesthesia,Shuo Tong ureteroscopy combined with flexible ureterscope were adopted.Usiy holmium laser lithotripsy,flexible ureterscope retrograde into the renal pelvis,using holmium laser to break the untreated residual stones of the Shuo Tong ureteroscopy,flexible ureterscope to find cysts.The Holmium laser is used to cut the most obvious part of the cystic compression of the renal pelvis,so that it is completely connected with the collecting system,and the double J tube drainage is left.Observe the patient’s temperature changes,routinely draw blood to check renal function(creatinine)within 24 hours after operation,then recheck B-ultrasound or KUB and CT after operation.RESULTS There was no major bleeding during and after the operation.The operation time was 35 to 60 minutes,with an average of(47±6.8)min,and the patients had no fever after operation.The length of post-hospitalization was 3-12 days,with an average of(5.92±2.38)days.No urinary leakage and no urinary pyogenic sepsis occurred.All the clinical symptoms of the patients disappeared after the operation.During the follow-up period of 3 to 24 months,20 cases of parapelvic cysts completely disappeared,5 cases of parapelvic cysts reduced by>50%,and 25 cases of kidney stones were basically cleared.CONCLUSION Shuo Tong ureteroscopy combined with flexible ureterscope holmium laser in the treatment of parapelvic cyst and kidney stone,can reduce the incidence of retrograde urinary tract infections and ensure the safety of patients after surgery.